Poly-propylene mesh mid-urethral slings (MUS) are currently the standard of care for the surgical treatment of stress type urinary incontinence. Despite its high efficacy and recommendations for use by international associations, MUS is not without complications. Iatrogenic pelvic pain is one of the rare mesh complications. Endoscopic management, transvaginal excision and/or retropubic removal of the mesh are the treatment options. In this video; we demonstrate laparoscopic complete TVT mesh removal in a patient  with  intractable pelvic pain.

A 59-year-old woman was referred to our department with intractable pelvic pain which started after transvaginal tape placement in 2011. She experienced progressively increased pelvic pain in the past 1 year. Physical examination revealed tenderness in the anterior vaginal wall, no vaginal mesh extrusion was detected. Firstly, transvaginal partial mesh removal was performed 1 year ago however the patient described incomplete pain improvement. Laparoscopic complete mesh removal performed. The patient was placed in the supine lithotomy position and the abdominal skin was draped and prepped in a sterile fashion. A 12F silicone Foley catheter was placed. A pneumoperitoneum of 12-14 mm Hg was established for port placement. The 10-mm camera port was placed approximately 1  cm superior to the umbilicus. Two 5-mm ports were placed 5 cm inferior to the umbilicus. Retropubic dissection was performed to identify the mesh. The left and right  TVT arm were carefully dissected towards the endopelvic fascia completely removed from this point  Cystoscopy revealed no injury in the bladder and the urethra. The retropubic space was closed.

The patient was discharged and foley catheter removed at postoperative 1. day. No postoperative complication was observed. Pelvic pain was relieved completely at 3. month control.

Iatrogenic pelvic pain is an uncommon complication of mid-urethral sling procedures. Partial and/or complete mesh removal is an effective treatment option in patients with pelvic pain. Laparoscopic TVT mesh removal can be a feasible, effective and minimally invasive treatment option for intractable pelvic pain after retropubic MUS.